Systematic review of the barriers and facilitators to dietary modification in people living with type 2 diabetes and pre-diabetes from South Asian ethnic populations.

AIMS: Lifestyle and dietary modification are effective in the prevention and management of Type 2 diabetes Mellitus (T2DM). However, South Asian (SA) populations living in Western countries have low adherence rates to healthcare advice and experience poor diabetes control and clinical outcomes compared with the general population. This systematic review aimed to summarise the barriers and facilitators of dietary modification within people from South Asian (SA) ethnicity with T2DM or pre-diabetes. METHODS: A systematic search of PubMed, Web of Science and Scopus generated 3739 articles, of which seven were included. Qualitative and quantitative data were inputted utilising COVIDENCE. Qualitative data were analysed by thematic analysis. RESULTS: Thematic analysis identified three facilitators: (1) cultural sensitivity, (2) health education and (3) support networks. Barriers include (1) healthcare inequity, (2) cultural insensitivity, (3) social pressures, (4) misconceptions and (5) time constraints. Good access to health care and motivation were the most common facilitators discussed. Misconceptions on T2DM management and cultural insensitivity contributed to the majority of barriers discussed. CONCLUSIONS: Culturally tailored interventions could improve adherence to diet modification in people with T2DM from SA ethnicity. Interventions involving the application of social media to challenge intergenerational stigmas and misinformation, distributing culturally appropriate resources and providing diets tailored to the SA palate could help.

Assessing preference and potential for working from anywhere: A spatial index for Ireland

Workforce flexibility in regard to the time and location of work can offer many advantages for individuals, businesses, communities and countries. Whilst neither universally viable nor uniformly valuable, there are those who may have a preference for such flexibility and there is certainly untapped positive potential to be explored across multiple impact categories. The COVID 19 pandemic has improved acceptability from both employee and employer perspectives and delivered a global ‘crash course’ in remote working. The varied potentials to work from anywhere, as well as differences in associated impact outcomes point to the value of targeted supports and careful planning. The Working from Anywhere Index offers a transferable fine scale spatial methodology to identify both the preferences and potential for working from anywhere. The value for policy support is demonstrated through application to a case country, Ireland, where illustrative scenarios explore the role of broadband provision, the placement of remote working hubs and the effect of shifts in employment types on the preferences and potential for working from anywhere. Impact analysis indicates that the scale of annual benefits for a plausible ‘2 day a week’ national working from anywhere scenario are substantial and offer the potential to save in the region of 1 bn car commuting kilometres per annum with associated societal benefits for emissions reduction and individual time savings.

Virtual exams: has COVID-19 provided the impetus to change assessment methods in medicine?

AIMS: The ongoing COVID-19 pandemic has disrupted and delayed medical and surgical examinations where attendance is required in person. Our article aims to outline the validity of online assessment, the range of benefits to both candidate and assessor, and the challenges to its implementation. In addition, we propose pragmatic suggestions for its introduction into medical assessment. METHODS: We reviewed the literature concerning the present status of online medical and surgical assessment to establish the perceived benefits, limitations, and potential problems with this method of assessment. RESULTS: Global experience with online, remote virtual examination has been largely successful with many benefits conferred to the trainee, and both an economic and logistical advantage conferred to the assessor or organization. Advances in online examination software and remote proctoring are overcoming practical caveats including candidate authentication, cheating prevention, cybersecurity, and IT failure. CONCLUSION: Virtual assessment provides benefits to both trainee and assessor in medical and surgical examinations and may also result in cost savings. Virtual assessment is likely to be increasingly used in the post-COVID world and we present recommendations for the continued adoption of virtual examination. It is, however, currently unable to completely replace clinical assessment of trainees. Cite this article: Bone Jt Open 2021;2(2):111-118.